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EE WORKSHEET PER EACH FACILIT% 04 FACILITY f <br /> IBA /JO L L IK" S ADDRESS ' <br /> [LING ADDRESS �Lf7- kZ�� <br /> Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (1 Additional Tanks x $50) <br /> State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total f Tanks) <br /> 'Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> Temporary closures x $80) (See above f3 to calculate surcharge) <br /> "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased 'and where the owner/operator has no intent <br /> of re-using tank. <br /> (/_ Permanent Closures x $90) <br /> Plan Check Fee $30. // /� <br /> ��Ll V �U <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> 5150 <br /> Ia. Existing Facility S 1st Tank <br /> 150 <br /> b. 3 Additional Tanks x S50 <br /> 2. State Surcharge, 4 Tanks x S56 <br /> 224 <br /> Total Number of Tanks 4 <br /> Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -A6 <br />